This document summarizes a study that evaluated combining keraring intracorneal ring segments with toric phakic implantable collamer lenses (ICL) to treat keratoconus. Fourteen eyes of 9 patients underwent keraring implantation followed by corneal collagen crosslinking (CXL). After 7 months, toric ICLs were implanted. Visual acuity and refraction improved after each step. By 1 year post-ICL implantation, uncorrected and best-corrected visual acuity increased while cylinder, maximum keratometry, and irregularity decreased. The study concluded this combination treatment can stop keratoconus progression and improve vision but longer-term studies in more patients are needed.

1. Keraring User Meeting
ESCRS LONDON
COMBINATION OF KERARING AND TORIC
PHAKIC IMPLANTABLE COLLAMER
LENS FOR KERATOCONUS
Efekan Coskunseven, MD
Dünya Göz / World Eye Hospital, Istanbul, Turkey
2014.

2. COMBINED TREATMENT OPTIONS
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+
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4. BSCVA & UCVA
0.63
0.82
0.87 0.88 0.89 0.89
0.3
0.4
0.79
0.83
0.85
0.88
1.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
Pre corsslinking Pre ICL After 7 days After 1month After 3months After 6months After 1year
BSCVA UCVA
0.56
0.88

5. METHODS
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Stop Progression
<1,5D Irregularity
Sph<-18 D
Cyl<5 D

6. COMBINED TREATMENT OPTIONS
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+
+ +

7. TORIC ICL IMPLANTATION AFTER
INTRACORNEAL RING IMPLANTATION FOLLOWED
BY CORNEAL COLLAGEN CROSSLINKING FOR
THE TREATMENT OF KERATOCONUS
+ +
J Cataract Refract Surg. 2013 Mar 13. doi:pii: S0886-
3350(13)00003-5. 10.1016/j.jcrs.2012.11.027

8. METHODS
 14 eyes of 9 patients with keratoconus
 ICLToric implantation after Intracorneal Ring Segment Implantation
followed by CXL (ICR+CXL).
7 M 8,4 M
•The Mean interval between ICR and CXL was 7 months and the mean
interval between CXL and ICLToric implantation was 6,4 months.
•The preoperative and postoperative visual acuity, refraction,
pachymetry and topography results were evaluated.
•The mean follow-up period was 7.2 months.

9. METHODS
Channel creation
(INTRALASE FS 60): 15
seconds.
Depth adjusted to 80% of
the thinnest point at
tunnel location.
Corneal incision : at
steep axis.
Keraring:4.4-5.6 mm
+ +
ICL operations were
performed 8,4 months
after CCL
ICL calculation was
based on post op
ICR+CXL refraction
ACD> 2,8 mm
0,1% B2 in 20%
Dextran T-500 30 min
UV (Peschkemed)
370 nm 3 mW/cm² for
30 min

10. ICL operations were
performed 8,4 months
after CCL
MOST DIFFICULT ;
ICL calculation was
based on post op
ICR+CXL refraction
ACD> 2,8 mm

11. 0.01
0.06
Pre-OP Post-ICR Post-ICR+CXL Post-ICL
UCVA BCVA
0.6
0.5
0.4
0.3
0.2
0.1
0
Pre-Op 0,01 0,16
Post-ICR 0,06 0,46
Post-ICR+CCL 0,08 0,48
Post-ICL 0,46 0,58
0.08
0.46
0.16
0.46
0.48
0.58
UCVA & BCVA
UCVA BCVA

12. CYLINDER & SEQ
-9.81 -9.56
-2.36 -1.88 -0.96
CYL SEQ
-4.73
-16.4
Pre-Op -4,73 -16,4
Post-ICR -2,36 -9,81
Post-ICR+CCL -1,88 -9,56
Post-ICL -0,96 -0,8
-18
-16
-14
-12
-10
-8
-6
-4
-2
0
-0.8
Pre-OP Post-ICR Post-ICR+CXL Post-ICL
CYL SEQ

13. Mean K
Mean K
58,36
55,77
59
58
57
56
55
54
53
52
Pre-Op 58,36
Post-ICR 55,77
Post-ICR+CCL 54,07
Post-ICL 54,03
54.07 54.03
51
Pre-OP Post-ICR Post-ICR+CXL Post-ICL

14. K1
56,1-54,7=1,4 D
54,78
K1
56,16
57
56
55
54
53
Pre-Op 56,16
Post-ICR 54,78
Post-ICR+CCL 53,54
Post-ICL 53,57
53.54 53.57
52
Pre-OP Post-ICR Post-ICR+CXL Post-ICL

15. K2
606,50-5,567,7-=536,8,7 D6=-3,81D
56,76
K2
60,57
Pre-Op 60,57
Post-ICR 56,76
Post-ICR+CCL 54,61
Post-ICL 54,48
54.61 54.48
62
60
58
56
54
52
50
Pre-OP Post-ICR Post-ICR+CXL Post-ICL

17. METHODS
7 M 8,4 M
<7 D
Irregularity
Sph<-18 D
Cyl<5 D
 Stop Progression
 <1,5D
Irregularity

18. CONCLUSION
 Topo-Guided Transepithelial PRK ,Toric Phakic IOL
Implantation , ICR implantation followed by CXL is
an effective treatment sequence that can stop
progression and improve vision and refraction in
select keratoconus patients
 However a long-term follow-up of a larger
population study is required to validate these
findings

19. THANK YOU
efekan.coskunseven@dunyagoz.com